Selecting patients for sacral nerve stimulation.

Patient selection for SNS remains empiric. A key is to think of voiding dysfunctions in terms of voiding behaviors and pelvic floor muscle function, not organ-based labels. Patients who have intractable urinary frequency, urgency, urge incontinence, or idiopathic urinary retention should be considered as prime candidates. Evidence of high-tone pelvic floor muscle dysfunction also may be demonstrated on routine physical examination, as well as diagnostic studies such as pelvic-floor EMG. A successful trial stimulation remains the best indicator for patient selection, and should be used as a routine diagnostic test among patients who have chronic, life-altering voiding complaints that cannot be resolved adequately by medications or behavioral interventions.